Study objective

Inappropriate antibiotic prescribing for acute respiratory tract infections is a common source of low-value care in the emergency department (ED). Racial and socioeconomic disparities have been noted in episodes of low-value care, particularly in children. We evaluated whether prescribing rates for acute respiratory tract infections when antibiotics would be inappropriate by guidelines differed by race and socioeconomics.

Methods

A retrospective cross-sectional analysis of adult and pediatric patient encounters in the emergency department (ED) between 2015 and 2023 at 5 hospitals for acute respiratory tract infections that did not require antibiotics by guidelines. Multivariable regression was used to calculate the risk ratio between race, ethnicity, and area deprivation index and inappropriate antibiotic prescribing, controlling for patient age, sex, and relevant comorbidities.

Results

A total of 147,401 ED encounters (55% pediatric, 45% adult) were included. At arrival, 4% patients identified as Asian, 50% as Black, 5% as Hispanic, and 23% as White. Inappropriate prescribing was noted in 7.6% of overall encounters, 8% for Asian patients, 6% for Black patients, 5% for Hispanic patients, and 12% for White patients. After adjusting for age, sex, comorbidities, and area deprivation index, White patients had a 1.32 (95% confidence interval, 1.26 to 1.38) higher likelihood of receiving a prescription compared with Black patients. Patients residing in areas of greater socioeconomic deprivation, regardless of race and ethnicity, had a 0.74 (95% confidence interval, 0.70 to 0.78) lower likelihood of receiving a prescription.

Conclusion

Our results suggest that although overall inappropriate prescribing was relatively low, White patients and patients from wealthier areas were more likely to receive an inappropriate antibiotic prescription.

中文翻译：

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急诊科抗生素处方不当存在明显的种族和社会经济差异

学习目的

针对急性呼吸道感染不适当的抗生素处方是急诊科 (ED) 低价值护理的常见原因。低价值护理事件中存在种族和社会经济差异，尤其是儿童。我们评估了当抗生素不适合时，急性呼吸道感染的处方率是否因种族和社会经济因素而异。

方法

对 2015 年至 2023 年间 5 家医院急诊科 (ED) 因急性呼吸道感染（根据指南不需要使用抗生素）的成人和儿童患者的情况进行回顾性横断面分析。使用多变量回归来计算种族、民族和面积剥夺指数与不适当的抗生素处方之间的风险比，并控制患者年龄、性别和相关合并症。

结果

总共纳入了 147,401 例 ED 就诊（55% 为儿童，45% 为成人）。到达时，4% 的患者被确定为亚洲人，50% 为黑人，5% 为西班牙裔，23% 为白人。在总体就诊中，有 7.6% 的患者出现了不恰当的处方，其中亚洲患者为 8%，黑人患者为 6%，西班牙裔患者为 5%，白人患者为 12%。在调整年龄、性别、合并症和面积剥夺指数后，与黑人患者相比，白人患者接受处方的可能性高 1.32（95% 置信区间，1.26 至 1.38）。居住在社会经济贫困程度较高地区的患者，无论种族和民族如何，获得处方的可能性较低 0.74（95% 置信区间，0.70 至 0.78）。

结论

我们的结果表明，尽管总体不适当处方相对较低，但白人患者和来自富裕地区的患者更有可能接受不适当的抗生素处方。